Essential to life but deadly in excess, cholesterol has been the subject of intense research for a century. This research has produced persuasive evidence that implicates the cholesterol-carrying low-density lipoproteins, or LDLs, as the main contributor to coronary artery disease.
Significance
Researchers have developed experimental, genetic, epidemiologic and therapeutic evidence that establishes a connection between LDL and atherosclerosis, which leads to heart disease. Along with continually adding to the body of knowledge about cholesterol, scientists have developed statin drugs to reduce the blood level of cholesterol.
Timeline
In 1910, a German chemist named Adolph Windaus discovered that atherosclerosis plaque from human aortas contained cholesterol in 20 to 26 times the concentrations of cholesterol found in normal aortas. According to Joseph Goldstein and Michael Brown in the September 2003 issue of the “Howard Hughes Medical Institute Bulletin," the Russian pathologist Nikolai Anitschov produced atherosclerosis of the aorta in rabbits by feeding them pure cholesterol in 1913. By 1938, a genetic connection had been established.
In the 1950s, intensive research worked out the complex method by which the body makes cholesterol. In 1976, Akira Endo, a Japanese scientist, discovered a method to block cholesterol synthesis, and that discovery led to the first statin drug to reduce the level of cholesterol in the body.
Benefits
Research on atherosclerosis has progressed beyond recognition of a disease to an understanding of contributing causes and effective therapies. Recommendations to the American public regarding heart disease and dietary fat began in the late 1950s when the correlation between dietary fat, cholesterol and heart disease was established.
Consistent advice over a period of 50 years to reduce total fat, saturated fat and cholesterol intake has led to a change in eating behaviors of Americans and measurable reductions in the incidence of deaths from heart disease. From 1950 through the late 1990s, deaths from heart disease decreased by 53 percent and deaths from stroke decreased by 70 percent, according to David Kritchevsky in the February 1998 issue of “The Journal of Nutrition.”
Potential
Recent research challenges traditional thinking about cholesterol. A study in the January 2010 issue of the University of Michigan Medical School Newsroom report suggests doctors should tailor treatment to an individual patient’s overall heart attack risk and use statin drugs less often rather than trying to drive down cholesterol to a target level. Risk factors taken into consideration would include age, family history and smoking status.
The study found that tailoring the approach was more effective at preventing heart attacks and strokes than the historical approach of treating patients with higher LDL levels to meet recommended LDL levels.
Theories/Speculation
The accumulated body of knowledge about cholesterol has led to new theories and avenues of inquiry. For instance, research targeting seven recently identified genes that regulate cholesterol may lead to the development of more effective cholesterol-reducing drugs. And researchers at the University of Rochester Medical Center are exploring the potential of a new gene therapy to reduce high cholesterol.
References
- Howard Hughes Medical Institute: Cholesterol
- "The Journal of Nutrition": History of Recommendations to the Public about Dietary Fat
- University of Michigan Health System: Treat the Risk, Not the Cholesterol
- U.S. News & World Report: Seven New Cholesterol Genes Discovered
- University of Rochester Medical Center: Enzyme Family Key to Future Treatments of High Cholesterol
